HME Authorization & Reimbursement Coordinator

Suburban Home Medical Equipment LLC; Greenfield (IN); On-site; USD 38,000 - 60,000; Full time

Job summary

Suburban Home Medical Equipment LLC seeks an HME Authorization & Reimbursement Coordinator to manage prior authorizations, insurance verification, and billing for home medical equipment.

You will handle medical records, ensure payer requirements, coordinate with carriers and patients, and support intake and order processing as needed. This role requires detail orientation and knowledge of HIPAA.

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• Experience in HME/DME, medical billing, insurance verification, or prior authorization is preferred.
• Strong attention to detail and organizational skills to manage multiple priorities.

Responsibilities

• Verify patient eligibility, benefits, coverage limitations, deductibles, co-pays, and payer requirements.
• Manage ongoing prior authorizations and re-authorizations for existing patients.
• Submit accurate authorization requests through payer portals, fax, and electronic systems.
• Post payments, adjustments, denials, and other billing transactions.
• Process incoming medical records and attach them to patient accounts.
• Serve as a point of contact for patients, referral sources, and insurance representatives.
• Provide back-up intake and order processing support as needed.
• Maintain HIPAA-compliant billing and medical documentation records.
• Collaborate with billing, intake, clinical, and quality teams to resolve documentation gaps.

Skills

Insurance verification

Prior authorization

Medical billing

Medical records

Healthcare administration

Attention to detail

Education

High school diploma or equivalent

Associate or Bachelor’s degree preferred

Tools

Brightree

McKesson

Microsoft Office

Job description

• Location 801 N State St,Greenfield, IN, 46140,United States
• Employee Type Benefitted 80

Description

The HME Authorization & Reimbursement Coordinator is responsible for managing ongoing prior authorizations, insurance verification, billing and reimbursement, and medical record documentation for Suburban Home Medical Equipment (HME). This role ensures authorization and coverage requirements are met, claims are processed accurately and timely, and required documentation is maintained in compliance with payer and regulatory guidelines. The position collaborates with insurance carriers, patients, referral sources, and internal teams to support continuity of equipment services, timely reimbursement, and regulatory compliance while providing backup support for HME intake and order processing as needed.

Insurance Verification & Prior Authorization

Verify patient eligibility, benefits, coverage limitations, deductibles, co-pays, and payer-specific requirements for HME equipment and services.

Manage ongoing prior authorizations and re-authorizations for existing patients to support continued equipment use and prevent interruptions in coverage.

Submit accurate and complete authorization requests through payer portals, fax, and electronic systems within required timeframes.

Monitor authorization expiration dates, coverage periods, and payer-specific requirements; proactively initiate renewals and follow up on pending requests.

Review clinical and supporting documentation to ensure medical necessity and compliance with payer requirements for initial and ongoing authorizations.

Communicate authorization approvals, denials, changes, and outstanding requirements to appropriate internal teams.

Research authorization and coverage issues, escalate delays as needed, and assist with denial management by gathering documentation and supporting appeals.

Maintain accurate authorization information and supporting records in HME and billing systems.

Prepare and submit accurate HME claims to Medicare, Medicaid, commercial insurance, and other applicable payers.

Verify patient demographics, insurance information, equipment details, authorizations, and supporting documentation for accuracy and completeness prior to billing.

Post payments, adjustments, denials, and other billing transactions accurately in the billing system.

Research and resolve billing, insurance, eligibility, and coverage issues in coordination with payers, patients, and internal staff.

Communicate with insurance companies and patients regarding billing inquiries, coverage requirements, and payment issues.

Gather supporting documentation for denied claims and assist with appeals and reimbursement-related follow-up.

Maintain accurate and organized billing and insurance records in accordance with payer requirements, HIPAA, and organizational policies.

Maintain knowledge of HME billing requirements, Medicare and Medicaid guidelines, and applicable payer policies.

Medical Records & Quality Coordination

Process incoming medical records, physician orders, faxes, and other clinical documentation, ensuring records are attached to the appropriate patient account or chart in a timely manner.

Send, track, and follow up on documentation requiring physician signatures or additional information.

Monitor outstanding orders, Certificates of Medical Necessity (CMNs), clinical documentation, and other medical record requirements to support compliance with payer guidelines and organizational policies.

Utilize physician portals and other systems to obtain medical records and supporting documentation as needed.

Maintain accurate physician and referral source information and related documentation.

Assist with medical record reviews and chart audits to identify documentation gaps and support regulatory compliance and quality improvement initiatives.

Compile documentation for medical record requests and internal or external reviews.

Collaborate with billing, intake, clinical, and quality improvement teams to resolve documentation deficiencies.

Maintain records in accordance with HIPAA, CMS requirements, payer guidelines, and organizational policies and procedures.

Communication & Customer Support

Serve as a point of contact for patients, referral sources, physicians, insurance representatives, and internal teams regarding HME authorizations, insurance coverage, billing, and documentation.

Respond to incoming calls and inquiries, providing timely and professional assistance with insurance, authorization, and billing questions.

Provide backup support for HME intake and order processing as needed, including receiving and reviewing referrals, entering patient and order information, verifying required documentation, and following up on missing information.

Assist with coordinating equipment orders and communicating with customer service, warehouse, delivery, and clinical teams to support timely equipment processing and delivery when providing intake coverage.

Provide intake on-call support as needed, including the possibility of participating in the on-call rotation to assist with after-hours intake needs.

Coordinate with internal departments to ensure authorization, documentation, billing, and reimbursement processes proceed efficiently.

Escalate unresolved or time-sensitive issues appropriately to help prevent delays in patient services or reimbursement.

Requirements

Basic Qualifications

High school diploma or equivalent required; associate or bachelor's degree preferred.

One to three years of experience in HME/DME, medical billing, insurance verification, prior authorization, medical records, or healthcare administrative support preferred.

Working knowledge of medical terminology, insurance processes, and healthcare documentation requirements.

Experience with HME/DME prior authorizations, billing, reimbursement, or payer requirements preferred.

Strong attention to detail and organizational skills, with the ability to manage multiple priorities and deadlines.

Strong written and verbal communication skills and a commitment to excellent customer service.

Ability to work independently, take initiative, and follow through on outstanding items.

Proficiency with Microsoft Office, Excel, and other computer systems; experience with HME/DME or billing platforms such as Brightree, McKesson, or similar systems preferred.

Ability to maintain confidentiality and comply with HIPAA and applicable regulatory requirements.

Summary

Suburban Home Medical Equipment is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Suburban Health at Home is committed to equal employment opportunity for all employees and to providing employees with a work environment free of discrimination, harassment, and workplace violence. All employment decisions at Suburban Health at Home are made based on job requirements, individual qualifications, or business need without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristics under applicable law. Suburban Health at Home creates a culture with zero tolerance for discrimination or harassment and seeks an environment of inclusion and respect at work.